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Nurse Navigators Lead to Cost Savings Jane Russell, MSN, RN, Director of Continuum of Care Good Samaritan | Vincennes, Indiana Indiana’s First County Hospital • Opened in February 1908 with 25 beds • 232- Bed Acute Care Hospital • Service area includes 9 rural Indiana counties and 4 rural Illinois counties 2 Frequent Flyers Great if you are in the airline industry. Not so good if you are in the ED. 3 Frequent Flyers Top two reasons our patients over utilized our ED: • Primary care • To attain medication 4 Our Frequent Flyer Greg 5 The Model • Assertive Community Treatment (ACT) Model • Safety Net Medical Home Initiative • National Committee for Quality Assurance (NCQA) Model 6 Benefits • Shorter waiting times for urgent needs • Nurse is available 27/7 when issues arise • Open five days a week with late hours on Monday, Wednesday and Thursday 7 Criteria for admission Six ED visits in six months Or Two inpatient admissions in six months And No provider Or No insurance 8 How Does It Work? • The patient is seen by a Nurse Practitioner (NP) and may then be referred to a Nurse Navigator for care coordination services. • Patients who do not receive a navigation referral are monitored at every visit to determine any change in status. • The nurse navigator completes a thorough assessment in the patient’s home (so the patient’s environment and social situation can be assessed) and brings it back to the PCMH team. • The patient’s assessment is reviewed at the morning clinic meeting or huddle. • The entire team reviews the assessment and makes changes to the treatment plan as needed. 9 How Does It Work? (continued) • The patient is followed by the NP, RN, and CM and his/her care is communicated in the daily huddles. • For patients who have no money to pay for medications, the Good Samaritan Pharmacy has developed a formulary that can be used by the PCMH at hospital cost which ensures patients are able to acquire medication as prescribed. • Case Managers utilize community resources to help with food, housing and transportation. • A nurse is available to PCMH patients 24 hours a day, seven days a week which helps build a relationship with the staff and decreases visits to the ER. 10 Nurse Navigators • Advocate for and assist the patients in navigating the health care system • Provide care coordination • Provide health literacy education • Obtain medication and medical supplies • Provide nutritional counseling 11 Case Manager • Provide Self-Managing Skill Development • Provide Education on Budgeting • Assist with Benefits and Resources • Teach Problem Solving Skills • Assist with Social Needs (Food, Housing, Employment, etc.) 12 Team Approach • The Daily Huddle occurs every morning before the clinic opens. • The first part of the huddle focuses on patients to be seen that day or patients who are in need of assistance that day. • The second part of the huddle reviews patients discussed the previous day, reports from the office visit or any other patient contact that was made. 13 Results Financial • In the third quarter 2015, ER visits for PCMH patients were reduced by an average of 39 per month. • Inpatient admissions were reduced by 11 a month. • Using an average ER charge of $2,082.86, and an average inpatient charge of $9,831.02 the Medical Home cost avoidance is now $974,778 for the year. • The cost avoidance saved in the ER more than covers the cost of running and staffing the medical home. 15 Patient Satisfaction • 93% of patients surveyed in Q4 of 2015 rated the care they received in the PCMH as very good and felt the staff worked very well together to provide very good care. • 96% reported the likelihood of recommending the clinic to someone else as very high. 16 Questions? Refrences http://store.samhsa.gov/product/Assertive-Community-Treatment-ACT-Evidence-Based-PracticesEBP-KIT/SMA08-4345 http://www.safetynetmedicalhome.org/ http://www.ncqa.org/Programs/Recognition/Practices/PatientCenteredMedicalHomePCMH.aspx http://pcmh.ahrq.gov (accessed December 30, 2014) Berwick, D., Nolan, T, & Whittington, J. “The Triple Aim: Care, Health, and Cost. Health Affairs 27, No. 3 (2014): 759-769. http://www.aha.org/advocacy-issues/quality/strategies-patient centered. (Accessed December 29, 2014) Carver, M. C., Jessie, A., (May 31, 2011) "Patient-Centered Care in a Medical Home" OJIN: The Online Journal of Issues in Nursing Vol. 16, No. 2, Manuscript 4. www.ihi.org/engage/initiatives/TripleAim/Pages/default.aspx. (accessed December 15, 2014) 18 Jane Russell, MSN, RN, Director of Continuum of Care | [email protected]